Monthly Archives: August 2008

I have been totally hectic. I haven’t had time to post or do much of anything else other than bounce around like a ping pong ball. I started my MPH class.

So, tonight. Made dinner, watched the Democratic convention with an old friend and drank some wine while working on some homework (not studying, it was a group session write up. I only had two glasses, but still, I don’t drink and study.) So, I turned in my assignment, friend left, DH went to bed, and what am I doing? Sleeping? Updating my calendar with the kids’ school schedules? Studying?

No, making chocolate and toffee chip banana muffins for a fundraiser at school tomorrow.

At midnight. I am nuts.

Tomorrow morning I am going to wake up, make a few pots of coffee, and host a breakfast bake sale outside the classroom to fund our trip to a regional convention.

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We will be having a panel discussion at our medical school, sponsored by our student AMWA group (which I am involved in), among other groups. I have helped come up with a few questions with my friend who is president of the research group (about publishing negative study outcomes, for example). I wanted to write up some questions regarding the recent HHS rule issue. Here is what I cam up with. FYI, most of the members of the panel will be osteopathic physicians. One panel member (Dr. P) is a lawyer, PhD and MPH who teaches culture and illness related courses in our MPH program.

Background information:
The US Dept of Health and Human Services (HHS) was writing up a new rule regarding women’s reproductive health care: link

It got leaked to the public. The rule primarily intends to extend the anti-discrimination laws, which already prohibit hiring employment discrimination based on religion, to specifically protect health care practitioners who want to exercise conscience clauses during the hiring process at federally funded clinics. (Health care practitioners who refuse to dispense or participate in any procedure or treatment that could be construed as morally objectionable, which the rule goes on to clarify as most forms of birth control and abortion, and includes refusing to refer to another practitioner or facility which would provide the health care that they are refusing to provide. The rule, other than a one word reference to euthanasia, spends extensive time discussing many aspects of reproductive health which may be morally objectionable to practitioners, including providing emergency contraception to rape victims.)

This rule would require that any clinic, hospital, research facility, etc. that provides any form of health care and receives federal funds cannot include willingness to provide these services as a prerequisite for hiring. This would include family planning clinics funded by the department of health, university hospitals, student pharmacies, military hospitals, rural clinics in underserved areas that get practitioners due to incentives from the National Health Service Corps or Indian Health Network, clinics receiving Title X funding to improve access to birth control to low income women and men, and any facility that accepts Medicaid or Medicare. Even if the main purpose of the facility is to provide (or research) birth control and family planning services, they will not be able to base hiring on an ability and willingness to provide these services.

In the language of the rule, the HHS also seeks to change two medical definitions to ideological definitions that would be legally very troubling. They define pregnancy as starting at fertilization of the egg, not at implantation, and define a fertilized egg as a human being. While this may be consistent with the most restrictive religious definitions, these definitions are not consistent with any medical definition, including that of ACOG (American College of Obstetrics and Gynecology). The rule also discusses specific forms of birth control, including emergency contraception, and supports non medical descriptions of their actions, defining them as abortificients.

ACOG, the AMA, and many other (mostly allopathic) organizations have written strongly worded statements condemning the rule. The rule was apparently written with a conservative political interest group, the Family Research Council, not with medical experts as consultants. A former Family Research Council staffer, Susan Orr, helped draft the rule when she was the Assistant Deputy Secretary of Population Affairs, the department responsible for overseeing access to contraception services for low income men and women. She was appointed to oversee Title X funding, even though she publicly declared that birth control is not a medical necessity, since fertility is not a disease.

In response to the reaction from medical organizations, the Secretary of the HHS, Mike Leavitt, has posted an official statement. He downplays the strongly ideological language of the rule, and says that the intent of the rule is to allow patients and doctors to line up with similar beliefs.
(link – they keep shifting the address, but this is the most current).

(Note to my fellow AMWA officer: OK, D, I know this is a lot of background, but this is a complicated issue. I think this would be an excellent question for Dr. Perez from the public health school. She teaches Culture and Illness, and I think the Secretary’s response that health care should be exclusionary towards people of other belief systems would be a good topic for her. If you are emailing them the background, maybe this would save them from having to do a lot of reading about it)

Question intro: Prominent medical organizations such as the American Medical Association and the American College of Obstetrics and Gynecologists have issued statements condemning a recent proposed rule by the Department of Health and Human Services. This rule would extend discrimination law to health care practitioners being hired at federally funded clinics who want to exercise conscience clauses, especially those who will refuse to provide contraception, terminations, and referrals to these services. This follows a history of complaints from professional medical organizations that this administration has been using ideology to shape federal health care policy, including FDA drug approvals, rules, and appointments to important departmental positions, in ways that are contrary to conventional professional medical community recommendations.

Question for physicians: How can organizations like the AOA, SOIMA, and ACOG become more involved in shaping federal health policy and preventing excessive political interest group influence?

Question for Dr. P: The secretary of Health and Human Services defended extending protection of conscience clauses by saying that patients should be able to select physicians who share the same beliefs. Do you think federal agencies should be promoting this as a goal? Do you think conscience clauses for practitioners who want to deny health care services and referral to health care services are a way to help patients find practitioners who share their belief systems?

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I wrote a reply on a post on the Feministing community site about breastfeeding in public. Since it is also a follow up to a post from here, and includes an frustrating interesting anecdote, I figured I should post it here, too.
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I wrote a post on here recently about feminism and breastfeeding. I go to medical school. In our health professions dept., the nursing students were giving presentations on research projects. One group had a poster on breastfeeding. I walked up to chat them up; it’s one of my favorite topics. One of the women who DID the presentation was saying how women were ashamed to breastfeed in public or in front of relatives, and that she would never do it.

And she was one of the nursing students who worked on the poster about the overwhelming health benefits of breastfeeding and how it should be encouraged.

I told them about the same article I wrote about, which echoed one of my frequent arguments. This is a health decision, not a social decision. The article argued it in a different way – formula companies (and other people, like this nurse) focus much more on emotional issues than on medical and health issues. Shame about doing what is the best medical decision shouldn’t be as important as it is. Other social considerations, too, like the whole backlash issue (don’t talk about breastfeeding benefits, which are real, significant medical benefits, because the small percent of women who truly try and cannot breastfeed may have their feelings hurt) also dominates the conversation.

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Again, my disclaimer, I have all the sympathy in the world for these women. They are obviously NOT who breastfeeding activism is aimed at. The mommy wars do not need to erupt every time this topic is brought up. We need to make this a medical discussion. Health problems with breastfeeding are nothing to be ashamed of.

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“Thank you for your steadfast pro-life efforts and for expanding the definition of abortion to include any activity that results in the termination of human life prior to implantation. This expanded definition will save the lives of more and more unborn human beings as we advance from conscience protections to legal restrictions on abortion. As research uncovers additional causes of miscarriage or preimplantation embryo loss, I look forward to further legislation against caffeine consumption, exercise, and other abortifacient activities among premenopausal women.”

“Science and the American people are not well-served when the government trumps basic health care needs with ideology and politics. This egregious regulation is an affront to health professionals and to American women. We urge the Administration to stop all further work on this very ill-advised effort.”

I hope ACOOG joins ACOG with an opinion. I may have to write to them to encourage such an action.

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I am such a nerd. I love a good email Table of Contents alert. One of the first things I did when I got accepted to medical school was access the library website and check out the journal access. EBSCO! Wheeeeee!

Well, I have been signed up to get free access articles from BioMed Central since before that. One open access journal that is one of my favorites is The International Breastfeeding Journal. This week they have several interesting articles, including:

I am off to read them now. I just took my pharm test yesterday, got a migraine, threw up a bit (while driving! great!), slept for more than 12 hours, missed school today, passed the test (whee!), made breakfast for the family, finished a project for an MPH class, and now have some “spare” time to read “recreational” material.

The first article is just an announcement about the Breastfeeding and feminism symposia at the UNC Chapel Hill School of Public Health. Ooh, I wish I went to med school there! A trip to the 2009 meeting is what I want for my birthday.

The second article is divine. I love how Hausman compares the “choice” discussion to that of choice and reproductive rights.

“Another Enfamil web page discusses “It’s Your Family’s Decision”: “Only mom and dad know
what will work best for their family. So, be confident in the choice that you make. The best way to deal with people who question your choice is to simply tell them, politely but firmly, that you have discussed how to feed your baby with your baby’s doctor. Feel good about your decision and be confident your baby is getting the essential nutrients he needs” [2]. Reading this I imagine what discussions of abortion would be like in the same register: “Look, I’ve discussed my decision to terminate this pregnancy with my doctor and she agrees it’s a good idea, healthy for me. It’s the right decision for my family as well. I’m confident in this decision, so you need to butt out.” To anyone familiar with the abortion debates, it’s clear that infant formula makers champion a rhetoric around “choice” that used to be a common approach to abortion rights but which is difficult to promote publicly today. ”

Love it! She comes close to my argument, which is this decision (breastfeeding, and other birthing decisions) is a health decision, not a social decision. She writes:

“Any decision a woman makes about reproduction thus becomes vaguely connected to her “rights” as a consumer, rather than her rights as a human being [3].”

She also examines the defensiveness over choosing the “right” choice and being a “good” mother, and appealing to emotional topics like love rather than health advantages.

Another great quote:

“In breastfeeding advocacy we see how much economic self-sufficiency makes breastfeeding a difficult practice to sustain for most women [5]. This is why, in my view, the structure of market work is one thing that must change in order to accommodate true maternal freedom, which would involve a relatively unconstrained ability to breastfeed one’s children.”

Yes, breastfeeding and mothering are not and should not be seen as opposing women’s economic freedom. In the way our employment paradigm is structured today, it is hard to breastfeed and work. I pumped at two jobs for more than a year, combined. I was able to bring S to work with me for six months, which was an incredible opportunity for both of us, and I worked from home 3 days a week with Zach. Most women do not have that kind of flexibility.

“Infant feeding choices—whether made by “heart” or “head”—are practiced in the context of the social, cultural, and economic forces that structure most people’s daily lives and intimate decisions. It is our responsibility, as feminists, to identify the constraints that reveal the “choice” itself to be not so much a choice but a class privilege, and then to figure out how to challenge the status quo that makes it so.”